Low Back Pain: What Physical Therapy Actually Does
Guideline-concordant care for non-specific low back pain — and why imaging is usually the wrong first move.
9 min read
Most acute low back pain is non-specific — meaning no single anatomical structure can be definitively blamed. Reassuringly, most resolves within six weeks with active care.
Clinical guidelines from the ACP and others recommend non-pharmacological first-line care: education, movement, and physical therapy. Early imaging is associated with worse outcomes and more invasive treatment downstream.
Physical therapy combines education, graded movement, manual therapy, and targeted exercise. The educational component — explaining that hurt does not always equal harm — is therapeutic in itself.
Red flags warrant evaluation before PT: progressive neurologic deficit, bowel or bladder changes, unexplained weight loss, fever, or trauma in older adults.
Chronic low back pain (>12 weeks) is a different beast. Multidisciplinary care including psychological strategies for pain coping outperforms isolated interventions.